San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - 21 March 1996, p.A13
Sabin Russell, Chronicle Staff Writer

Addressing the opening session of the eighth annual National Update Conference on AIDS, Fisher condemned the emergence of HMO-style managed medical care, but nevertheless urged patients to find a way to work with it.

"The days of Dr. Marcus Welby are over," she said. "We have descended into a Brave New World where doctors are rewarded for avoiding expensive treatments."

Fisher, a mother and former television producer diagnosed with AIDS, delivered a spellbinding speech that echoed her address to the 1990 Republican presidential convention, an event that brought her into national prominence.

"I am pampered by my insurance company because I made a 13-minute speech to a bunch of politicians in Houston," said Fisher. "But there are nearly a million of my brothers and sisters who are not so pampered, who are consigned to the least possible care, at the least possible cost."

But Fisher also suggested that the new medical system of managed care that is sweeping the nation can respond to pressure from AIDS patients. "Let those who pursue profits lead the drive to prevention," she said.

Fisher urged a new national strategy that broadens the coalition of AIDS advocates. "We must learn from the virus," she said. "It only cares that we are human. It does not care if we are black or white, gay or straight."

She also said leadership in the battle against AIDS should not be limited to those with the disease. "Compassion is the criteria for leadership, not infection," she said. "Otherwise, we are condemned to a future without stable leadership, and I fear that is no future at all."

Fisher's call for a new pragmatism in the fight against AIDS was echoed by Dr. Mark Smith, executive vice president of the Kaiser Family Foundation, a Menlo Park- based think tank that is not affiliated with health care giant Kaiser Permanente.

Managed care, he said, was a reasoned response to a health care system that had gotten financially out of control. It is now a fact of life in American medicine. "If you don't like it," he said, "to borrow a phrase from Queer Nation, `Get used to it.' "

Smith urged activists to spend their energy working with HMOs to improve AIDS care, rather than fighting against them. "These doctors took the same oath I did," he said. "They don't sit up at night thinking how they can screw needy people out of the treatment they need."

An AIDS physician whom President Clinton wooed unsuccessfully for the job as White House AIDS czar, Smith advised patients to make sure their HMOs have doctors experienced in treating the disease, and have a well-defined standard of treatment.

He said much of the resentment against HMOs is derived from the fact that they are successfully curbing the income of doctors and nurses, and are leading to the loss of union jobs and the closure of inefficient hospitals. "Yes, they will do that," he said. "That is, after all, the point. . . . God never guaranteed us an income, folks."
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